Reliability of selective pulmonary arteriography in the diagnosis of pulmonary embolism

Effect of anatomic distribution of pulmonary emboli on interobserver agreement in the interpretation of pulmonary angiography.

“…Thus, the acceptable overall agreement of 81% for pulmonary angiography in the PIOPED study actually represents excellent agreement for third-and fourth-order (lobar or segmental) arteries and relatively poor agreementfor fifth-order or higher arteries. Similarly, in 1987, Quinn et al [12] found a mean interobserver agreement of 86%; how ever, the three angiographers in that study agreed on 100% of positive cases with seg mental or larger emboli and on only 13% (2/ 15) of casesgradedassubsegmental. Theseresults are corroboratedin our study, in which we found unanimous initial interob server agreementconcerning the presenceor absenceof pulmonary embolism in 91% of cases.…”

Desfechos clínicos após investigação para Embolia Pulmonar utilizando TC de tórax/membros inferiores

“…The accuracy of a diagnostic test is usually measured by comparing its performance with a reference gold standard, and in the case of PE, CPA has been considered the reference test. However, besides its invasive nature, CPA also has its own limitations concerning accuracy and interobserver agreement 22,23 . Such limitations of the reference standard partially compromise the assessment of the diagnostic characteristics of new tests.…”

Exames de confirmação

“…2010;36(supl.1):S1-S68 senta limitações de sensibilidade e especificidade no estudo dos vasos subsegmentares. (9) Por ser um método invasivo e também de baixa disponibilidade, seu emprego como método inicial é usualmente limitado aos pacientes instáveis com contraindicação ao uso de trombolíticos e que podem se beneficiar da trombectomia por cateter, embora não tenha sido demonstrado ainda o impacto dessa abordagem.(C). Nos pacientes estáveis, a indicação da angiografia ocorre quando os resultados dos exames não invasivos são inconclusivos, ou quando há discordância entre os mesmos e a clínica.…”